Presidential Agendas Essay

Over the years, the complex U.S. pharmaceutical market has been marked by high and mounting list prices, increasing out-of-pocket (OOP) costs, and an epoch of high-cost drugs lacking competition (Health and Human Services, 2018). The high cost of prescription drugs threatens healthcare budgets, and limits funding available for other areas in which public investment is needed. In countries without universal healthcare, the high cost of prescription drugs poses an additional threat: unaffordable out-of-pocket costs for individual patients. For example, approximately 25% of Americans find it difficult to afford prescription drugs due to high OOP costs (Rajkumar, 2020). As a result, the last three presidents used prices of prescription drugs as among their key presidential campaigns.

In his American First campaign, President Trump’s healthcare vision was to place American patients, families, and seniors first by providing more choice, better care, and lower costs.  He issued unprecedented reforms that dramatically lowered the price of prescription drugs, including lowering drug prices for the first time in 51 years, launching an initiative to stop global freeloading in the drug market, and finalizing a rule to allow the importation of prescription drugs from Canada (The White House, 2020). Today, President Biden is laying out his vision for reducing the high cost of prescription drugs. As part of his Build Back Better agenda, he’s calling on Congress to address this crisis and allow Medicare to negotiate drug prices, significantly reducing costs for millions of Americans. Specifically, the President’s plan includes allowing Medicare to Negotiate Drug Prices (The White House, 2021). In my view, what I would do differently is to push for regulation of monopolies, which are the principal cause of high cost of prescription medications, especially cancer drugs. Unregulated monopoly over an essential product can lead to unaffordable prices that threaten the life of citizens (Rajkumar, 2020).

The attempt to reduce the prices of prescription drugs is a public policy, and the process entails four sequential phases, namely agenda setting, formulation, implementation, and evaluation (Shiffman, 2016). Agenda setting is the issue-sorting stage, during which the concern of rising cost of prescription drugs is brought to the attention of presidential candidates and other policymakers while others receive minimal attention or are neglected completely (Lamb et al., 2015). The importance of agenda setting lies in the fact that there are thousands of issues that might occupy the attention of policy makers, but in practice only a handful actually do gain their consideration. Besides, mainstream media can highlight as the key cornerstones a presidential hopeful.

References

Health and Human Services. (2018). American patients first – The Trump administration blueprint to lower drug prices and reduce out-of-pocket costs. HHS. https://www.hhs.gov/sites/default/files/AmericanPatientsFirst.pdf

Lamb, G., Newhouse, R., Beverly, C., Toney, D. A., Cropley, S., Weaver, C. A., Kurtzman, E., Zazworsky, D., Rantz, M., Zierler, B., Naylor, M., Reinhard, S., Sullivan, C., Czubaruk, K., Weston, M., Dailey, M., & Peterson, C. (2015). Policy agenda for nurse-led care coordination. Nursing Outlook, 63(4), 521–530. https://doi.org/10.1016/j.outlook.2015.06.003

Rajkumar, V. (2020). The high cost of prescription drugs: Causes and solutions. Blood Cancer Journal, 10(6). https://doi.org/10.1038/s41408-020-0338-x

Shiffman, J. (2016). Agenda setting in public health policy. In International Encyclopedia of Public Health (Second Edition, Vol. 1). Elsevier. https://doi.org/10.1016/B978-0-12-803678-5.00007-2

The White House. (2020). Healthcare. https://trumpwhitehouse.archives.gov/issues/healthcare/

The White House. (2021, August 12). Fact sheet: President Biden calls on congress to lower prescription drug prices. https://www.whitehouse.gov/briefing-room/statements-releases/2021/08/12/fact-sheet-president-biden-calls-on-congress-to-lower-prescription-drug-prices/

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Another issue regarding excessive prescription costs, also targeted during the Trump administration pertains to Medicare beneficiaries. “One of the largest drivers of increasing Medicare spending is the growing prices for physician-administered separately payable Medicare Part B drugs, which have risen an average of 11.5 percent annually since 2015, with total spending of approximately $30 billion in 2019” (Center for Medicare and Medicaid Services, 2020). The increasing high costs are attributed to the lack of competitive markets for Medicare part D drug costs and an incentive system that gives payments to hospitals, physicians and other practitioners on the volume of drugs they use and the price drug manufacturers set (Center for Medicare and Medicaid Services, 2020). President Trump’s administration introduced the Most Favored Nation (MFN) Model. This model aimed to lower prescription drug costs by paying no more for high-cost Medicare Part B drugs and the lowest price that drug manufacturers receive in other similar countries. Medicare beneficiaries would also pay lower coinsurance for these high-cost Part B drugs and not pay coinsurance on the add-on payment (Center for Medicare and Medicaid, 2020).

Both Presidents took aim at prevalent problems surrounding the issue of prescription drug costs. However, it continues to be a complex and difficult issue to address. Meanwhile, Americans continue to be left with minimal alternatives. In my view, until the influence of pharmaceutical lobbyists is addressed accordingly, pharmaceutical companies will continue to have the necessary leverage they need to control the price of prescription drugs and Congressional votes. This is where change should begin.

References

Centers for Medicare and Medicaid Services. (2020). FACT SHEET: Most Favored Nation Model for Medicare Part B Drugs and Biologicals Interim Final Rule with Comment Period. https://www.cms.gov/newsroom/fact-sheets/fact-sheet-most-favored-nation-model-medicare-part-b-drugs-and-biologicals-interim-final-rule

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

The White House. (2011). Fact Sheet: Obama Administration Takes Action to Reduce Prescription Drug Shortages in the U.S. https://obamawhitehouse.archives.gov/the-press-office/2011/10/31/fact-sheet-obama-administration-takes-action-reduce-prescription-drug-sh

Tamisha,

You have provided great insight on one of the consistent issues that people face having to factor in the cost of their medications and may have to go without other things because of it. According to a Preventing Chronic Disease article, “costs of medications and non-adherence to the Provider’s treatment regimen are linked ( Baker-Goering, 2019).” Most people are less likely to adhere to plans if they cannot afford medication or its substituted recommendation. There have been numerous instances where patients, family members, etc., who have voiced concern about not being able to afford their current medications, then were prescribed new medications. I want to note that most had insurance, prescription cards, etc., to help reduce the cost. Insurance plans and coverage are evolving daily as well, so range is changing.

References:

Baker-Goering, M. M., Roy, K., & Howard, D. H. (2019). Relationship Between Adherence to Antihypertensive Medication Regimen and Out-of-Pocket Costs Among People                      Aged 35 to 64 With Employer-Sponsored Health Insurance. Preventing Chronic Disease, 16, 1–6. https://doi.org/10.5888/pcd16.180381

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Tamisha, I totally agree with you that the cost of prescription drugs has been a rallying issue for presidential candidates over the years. As a candidate in 2016, President Trump ran on prescription drug prices, stressing the need for government negotiation to align prices paid in the United States with lower prices paid in other countries (Commonwealth Fund, 2020). As president, he proposed policies to address patient out-of-pocket costs and increase competition to lower drug prices, largely focusing on Medicare. Many of these efforts have been derailed, either because they were abandoned or blocked by courts, or because Congress has failed to enact drug-pricing legislation (Nather, 2016). Trump included drug-pricing proposals in his 2018 “American Patients First” blueprint and in his annual budgets, and he also announced executive orders to address drug prices. However, he does not have a specific election platform on drug pricing. On price increases, President Trump updated Medicare’s website to make list price increases more transparent, while President Biden promised he would impose a cap on drug price increases that exceed the rate of inflation (Commonwealth Fund, 2020). A tax penalty would be levied on companies that violate this restriction. The translation of the above political agendas into practical policies appears to be an uphill task, with legislatures sharing conflicting views and positions along political lines. In my view, Republicans appear to undo all the policies on prescription drugs costs proposed by the Democrats and vice-versa. What do you think?

References

Commonwealth Fund. (2020, October 7). Health care in the 2020 presidential election: Prescription drugs. https://www.commonwealthfund.org/blog/2020/health-care-2020-presidential-election-prescription-drugs

Nather, D. (2016, January 26). Why Donald Trump would have the same problems as Democrats on Medicare drug prices . Stat News. https://www.statnews.com/2016/01/26/trump-medicare-drug-prices/

Hi Tamisha,

I enjoyed reading your post, you provided great insight on the on-going issues patients have faced over several years. The cost of medications is astronomical and very challenging for some patients to pay for their medications. Because patients struggle with the cost of medications this leads to non-adherence to their medication regimen and individualized treatment plan by the provider. According to an article “Preventing Chronic Disease” costs of medications and non-adherence to the providers treatment plan are linked (Baker-Goering 2019.)

Reference:

Baker-Goering, M. M., Roy, K., & Howard, D. H. (2019). Relationship Between Adherence to Antihypertensive Medication Regimen and Out-of-Pocket Costs Among People                      Aged 35 to 64 With Employer-Sponsored Health Insurance. Preventing Chronic Disease, 16, 1–6. https://doi.org/10.5888/pcd16.180381

Hi Tamisha,

Thanks for your post, I enjoyed reading it.  The cost of prescription drugs in the United States and around the world is ridiculously high. According to Rajkumar (2020), about 350 billion dollars was spent on prescription drugs alone in the U.S.A  in the year 2020 and it is expected to sky rocket in the upcoming years.  Most people are negatively impacted with this high cost of these prescription drugs especially those who have to pay out of pocket in order to have their medication, (Baker,2017).  There was a time that a patient complained of the cost of his medication making it impossible for him to be able to use it for his chronic condition, he had stated that he was very sure he would die out of his inability to purchase his drugs.  It is very important that policies are implemented to help curb this serious situation.  Nice post!

References

Baker D. E. (2017). High drug prices: so who Is to blame?. Hospital pharmacy, 52(1), 5–6. https://doi.org/10.1310/hpj5201-5

Rajkumar, V. S. (2020). The high cost of prescription drugs: causes and solutions. Blood cancer journal, 10(6), 71. https://doi.org/10.1038/s41408-020-0338-x

Health care costs have been an issue for years, whether it be the cost of individual health insurance, the cost of medications and supplies, or the cost for procedures and doctor’s visits. While we cannot make/change health care laws ourselves, we can influence law makers. What is the best way nurses can make a large impact on lawmakers and influence them to create legislation that is beneficial for nurses and patients?

Dr. Mooring

One of the best ways for nurses to create change in policies and law would be to contact senators and lawmakers, urging them to keep the best interests of patients and nurses in their legislation.

Nurses should not be constrained by policy. Rather, nurses must communicate their unique viewpoints to bureaucrats, agency personnel, politicians, and others in public service about the responsibilities of nurses, the needs of patients and nurses, and how their cost-efficiency affects long-term healthcare in the U.S (Milstead & Short, 2019).

Additionally, when nurses choose to take on the role of policy advocate in order to effect systemic change, they frequently must leave their comfort zone of clinical practice and enter unfamiliar arenas where laws and regulations affecting patient care are developed and battles over scarce resources are negotiated and decided (Abood, 2007). As a result, nurses have the experiences to share that cover many aspects of patient care.

References

Abood, S. (2007). Influencing healthcare in the legislative arena. The Online Journal of Issues in Nursing, 12(1).

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No1Jan07/tpc32_216091.html?css

Milstead, J., Short, N. (2019). Health policy and politics: A nurse’s guide. 6^th ed. Jones & Bartlett Publishing.

Janelle,

The rising costs of drugs has been an issue for decades, and has been the center of presidential concerns. On

average, Americans pay two to three times as much for their prescription drugs, as people from other countries (The White

House,2021). Some Americans have to make a choice between paying their bills, eating, or buying their medications. While I

understand that it is expensive for the research and development of these medications, the profit margin could be

exponentially lower.  I liked that you pointed out that monopolies were part of the issue. “Monopolistic companies have a greater

ability to raise prices because they don’t face the full pressure of a competitive market,”(Open Market, n.d.). Competition is a

vital component to decreasing costs and increasing quality of products. We need congress to stop these monopolies and help the

American people!

References

The White House. (2021, August 12). Fact Sheet: President Biden Calla on Congress to Lower Prescription Drug Prices.

https://www.whitehouse.gov/briefing-room/statements-releases/2021/08/12/fact-sheet-president-biden-calls-on-congress-to-

lower-prescription-drug-prices/

Open Markets. (n.d.). High Drug Prices and Monopoly. https://www.openmarketsinstitute.org/learn/drug-prices-monopoly

Hi Janelle, I do agree with you in your post. The cost of some prescription meds are astronomically high. I know it takes money to make these meds but there is no way that any medication should cost thousands or even hundreds of dollars per prescription. The ones I really see that the government have tried to crack down on are the producers of diabetic medications. With so many people who suffer from diabetes, these manufacturers are making millions off the poor people who already suffer from this terrible disease.

You chose a critical topic to discuss. People are very concerned about the cost of their prescriptions, and it is interrupting their daily lives.  There have been instances when the elderly have been unable to afford their medications. If one cannot afford their prescriptions, they are less likely to have the desired outcome. According to a Frontiers in Medicine article,  older adults have less than ideal outcomes due to not entirely adhering to the treatment regimens. ( Zhang, 2021). Lack of financial resources to cover medications remains a leading barrier within the health care system.  It is suggested that people will be more likely to get better or adhere to the prescribed treatment plan if prescription costs are not so high.

References:

Zhang,  W. Gang Lv, Xiaomo Xiong, & Minghui Li. (2021). Effect of Cost-Related Medication Non-adherence Among Older Adults With

Medication Therapy Management. Frontiers in Medicine, 8. https://doi.org/10.3389/fmed.2021.670034

Hello Janelle!

Very informative post! As you mention, the current presidential agenda has created an unprecedented demonstration of the desire to decrease drug prices. The ability for Medicare to negotiate the price of medication, will undoubtedly make it them more accessible to those in need. Drugs that have been in the market for a set number of years, 9 years for smaller molecular drugs and 12 years for bigger molecular drugs will have their price tags mitigated to better serve the public. It is also projected, that by year 2025 20 different drugs will be in arrangement to reach better pricing with Medicare Part B & D. However, the negotiations will also prove fair for the manufactures while also boosting opportunities for invention on the part of smaller pharmaceuticals attempting to find remedies to old and new diseases. Pharmaceutical companies that refuse the participate in this initiative will be heavily taxed. Senior will directly experiment a decrease in out of pocket cost, as well as diabetic patients which will see a significant drop in insulin prices (The White House, 2021).

The White House. (2021, November 2). President Biden Announces Prescription Drug Pricing Plan in.   Build Back Better Framework. https://www.whitehouse.gov/briefing-room/statements-releases/2021/11/02/president-biden-announces-prescription-drug-pricing-plan-in-build-back-better-framework

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Very informative post such a critical topic to provide insight on. Patients are  concerned about the expensive cost of their medications, and it affects their lives.  There have been times when patients especially from lower socio-economic populations and elderly patients that have been unable to afford their prescriptions to manage their co-morbidities. If patients are unable to afford their medications, they are less likely to achieve the desired outcome. According to a Frontiers in Medicine article,  older adults have less than ideal outcomes due to not entirely adhering to the treatment regimens. ( Zhang, 2021). Lack of financial resources to cover medications remains a leading barrier within the health care system.  More patients will be more likely to adhere to the medication regimen and treatment plan if the cost of meds are not astronomical.

References:

Zhang,  W. Gang Lv, Xiaomo Xiong, & Minghui Li. (2021). Effect of Cost-Related Medication Non-adherence Among Older Adults With

Medication Therapy Management. Frontiers in Medicine, 8. https://doi.org/10.3389/fmed.2021.670034

Janelle,

I completely agree with your opinion on regulating monopolies of essential products. During times of crisis, larger companies tend to take advantage of a vulnerable population, profiting from widespread panic.